DESCRIPTION: Exposure to blood and body fluids, most often through the use of conventional unsafe needles that transmit bloodborne infections to health care workers, continues to be the most life threatening risk facing healthcare workers (Lipscomb & Borwegen, 2000). Estimates indicate that 600,000 to 800,000 such injuries occur annually (Henry and Campbell, 1995, EPINet, 1991). Risk factors for needlestick injuries in the acute care setting have been elucidated, however little is known about the risk factors facing the 670,000 workers employed by about 20,000 home care agencies serving more than 7 million individuals each year. Also, hundreds of thousands of home care workers are self-employed or have some type of informal work arrangement. The proposed research will contribute to our understanding of the risk of exposure to blood among these workers. In addition, the proposed research will develop, implement and evaluate effective intervention strategies. The proposed research will bring together a broad range of experts and practitioners in the fields of occupational health, epidemiology, survey research, intervention effectiveness research, worker training, and home health care to address the following specific aims: 1) To compare and contrast blood exposure and available hazard controls among Registered Nurses (RN) and personal care assistants (PCA) working in the home; 2) To assess the relationship between organization of work (OOW) factors, blood exposure, and use of available hazard controls in home care workplaces; 3) To describe home care agency Exposure Control Plans (as required by the 2000 federal Needlestick Safety and Prevention Act) in Maryland and Illinois; 4) To evaluate changes in home care agency Exposure Control Plans following receipt of bloodborne pathogen standard compliance assistance materials; 5) To implement a union-based participatory primary prevention intervention for the reduction of blood exposure among PCAs; and 6) To evaluate the impact of a union-based primary prevention strategy on PCAs exposure to blood.